Methods: The sample of former and current smokers (n=15,965), nationally representative of 107.9 million adults, was obtained from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). DSM-5 criteria were used to determine past-year AUD/SUDs remission. Respondents indicated whether they used e-cigarettes for help with tobacco use in the last 12 months. We used bivariate and multivariate logistic regression models to examine associations between sociodemographic factors and smoking status. Using a series of multivariate-adjusted logistic regression models, we also examined remission among former smokers and among users of e-cigarettes for cessation. Analyses were performed in Stata 16.0.
Results: Of the sample, 22.8% were in past-year AUD remission and 11.7% were in past-year SUDs remission. Former smokers had lower rates of SUDs remission (8.5%) compared with current smokers (13.9%) (p<.001). Among former smokers (n=5,926), factors positively associated with AUD remission included: gay/lesbian (adjusted odds ratio [AOR], 4.38; 95% confidence intervals [CI], 1.26-15.27) or bisexual identity (AOR, 17.69; 95% CI, 1.68-185.85) and past-year SUDs remission (AOR, 2.14; 95% CI, 1.01-4.53). Factors positively associated with SUDs remission included being employed (AOR, 3.44; 95% CI, 1.34-8.86) and past-year AUD remission (AOR, 2.32; 95% CI, 1.07-5.01). Past-year drug/alcohol treatment and past-year anxiety disorder were positively associated with AUD and SUDs remission (p<0.05 for each). Age and female sex were associated with a decreased likelihood of current AUD or SUDs remission (p<0.05 for each).
Among users of e-cigarettes for cessation (n=383), non-Hispanic Black (AOR, 0.16; 95% CI, 0.05-0.71) and gay/lesbian (AOR, 0.07; 95% CI, 0.01-0.66) individuals had decreased likelihood of AUD remission. Factors positively associated with SUDs remission were bisexual identity (AOR, 8.09; 95% CI, 1.35-48.32); past-year AUD remission (AOR, 1.84; 95% CI, 1.02-3.34); and past-year drug/alcohol treatment (AOR, 2.96; 95% CI, 1.12-7.82). Female sex was associated with a decreased likelihood of current SUDs remission (AOR, 0.33; 95% CI, 0.17-0.63).
Conclusions/Implications: Cessation-related e-cigarette use was not associated with smoking status, and e-cigarettes may not serve as an effective smoking cessation tool for some individuals attempting AUD/SUDs recovery or smoking abstinence. Social workers who work with adults in or seeking AUD/SUDs treatment should assess e-cigarette use and reason for use.